Provider Demographics
NPI:1811303407
Name:LAWRENCE MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:LAWRENCE MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALISTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:785-505-2988
Mailing Address - Street 1:1130 W 4TH ST
Mailing Address - Street 2:SUITE 3201
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1328
Mailing Address - Country:US
Mailing Address - Phone:785-505-5885
Mailing Address - Fax:785-505-3322
Practice Address - Street 1:1130 W 4TH ST
Practice Address - Street 2:SUITE 3201
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1328
Practice Address - Country:US
Practice Address - Phone:785-505-5885
Practice Address - Fax:785-505-3322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0435907207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty